Pub Date : 2024-09-06DOI: 10.1007/s00256-024-04792-3
Evan H Richman, Parker J Brown, Ian D Minzer, Joseph C Brinkman, Michael S Chang
Objective: To analyze and quantify the change in United States of America Medicare reimbursement rates for the 30 most commonly performed spinal imaging procedures.
Materials and methods: The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was utilized to find and extract the 28 most billed spinal imaging procedures. All data was adjusted for inflation and listed in 2020 US dollars. Percent change in reimbursement and Relative Value Units between 2005 and 2020, both unadjusted and adjusted, were calculated and compared. Additionally, percent change per year and compound annual growth rate were calculated and compared.
Results: After adjusting for inflation, the average reimbursement for all analyzed spinal imaging procedures between the years 2005 and 2020 decreased by 45.9%. The adjusted reimbursement rate for all procedures decreased at an average 4.3% per year and experienced an average compound annual growth rate (CAGR) of - 4.4%. Magnetic resonance imaging (MRI) had the most substantial adjusted decline of all imaging modalities at - 72.6%, whereas x-ray imaging had the smallest decline at - 27.33%. The average total RVUs per procedure decreased by 50.1%, from 7.96 to 3.97.
Conclusion: From the years 2005 to 2020, Medicare reimbursement significantly decreased for all advanced imaging modalities involving the most common spinal imaging procedures. Among all practices, imaging procedures may be experiencing some of the largest decreases from Medicare reimbursement cutbacks.
{"title":"Declining Medicare reimbursement in spinal imaging: a 15-year review.","authors":"Evan H Richman, Parker J Brown, Ian D Minzer, Joseph C Brinkman, Michael S Chang","doi":"10.1007/s00256-024-04792-3","DOIUrl":"https://doi.org/10.1007/s00256-024-04792-3","url":null,"abstract":"<p><strong>Objective: </strong>To analyze and quantify the change in United States of America Medicare reimbursement rates for the 30 most commonly performed spinal imaging procedures.</p><p><strong>Materials and methods: </strong>The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was utilized to find and extract the 28 most billed spinal imaging procedures. All data was adjusted for inflation and listed in 2020 US dollars. Percent change in reimbursement and Relative Value Units between 2005 and 2020, both unadjusted and adjusted, were calculated and compared. Additionally, percent change per year and compound annual growth rate were calculated and compared.</p><p><strong>Results: </strong>After adjusting for inflation, the average reimbursement for all analyzed spinal imaging procedures between the years 2005 and 2020 decreased by 45.9%. The adjusted reimbursement rate for all procedures decreased at an average 4.3% per year and experienced an average compound annual growth rate (CAGR) of - 4.4%. Magnetic resonance imaging (MRI) had the most substantial adjusted decline of all imaging modalities at - 72.6%, whereas x-ray imaging had the smallest decline at - 27.33%. The average total RVUs per procedure decreased by 50.1%, from 7.96 to 3.97.</p><p><strong>Conclusion: </strong>From the years 2005 to 2020, Medicare reimbursement significantly decreased for all advanced imaging modalities involving the most common spinal imaging procedures. Among all practices, imaging procedures may be experiencing some of the largest decreases from Medicare reimbursement cutbacks.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-04DOI: 10.1007/s00256-024-04786-1
Wolfgang Wirth, Susanne Maschek, Anna Wisser, Jana Eder, Christian F Baumgartner, Akshay Chaudhari, Francis Berenbaum, Felix Eckstein
Objective: A fully automated laminar cartilage composition (MRI-based T2) analysis method was technically and clinically validated by comparing radiographically normal knees with (CL-JSN) and without contra-lateral joint space narrowing or other signs of radiographic osteoarthritis (OA, CL-noROA).
Materials and methods: 2D U-Nets were trained from manually segmented femorotibial cartilages (n = 72) from all 7 echoes (AllE), or from the 1st echo only (1stE) of multi-echo-spin-echo (MESE) MRIs acquired by the Osteoarthritis Initiative (OAI). Because of its greater accuracy, only the AllE U-Net was then applied to knees from the OAI healthy reference cohort (n = 10), CL-JSN (n = 39), and (1:1) matched CL-noROA knees (n = 39) that all had manual expert segmentation, and to 982 non-matched CL-noROA knees without expert segmentation.
Results: The agreement (Dice similarity coefficient) between automated vs. manual expert cartilage segmentation was between 0.82 ± 0.05/0.79 ± 0.06 (AllE/1stE) and 0.88 ± 0.03/0.88 ± 0.03 (AllE/1stE) across femorotibial cartilage plates. The deviation between automated vs. manually derived laminar T2 reached up to - 2.2 ± 2.6 ms/ + 4.1 ± 10.2 ms (AllE/1stE). The AllE U-Net showed a similar sensitivity to cross-sectional laminar T2 differences between CL-JSN and CL-noROA knees in the matched (Cohen's D ≤ 0.54) and the non-matched (D ≤ 0.54) comparison as the matched manual analyses (D ≤ 0.48). Longitudinally, the AllE U-Net also showed a similar sensitivity to CL-JSN vs. CS-noROA differences in the matched (D ≤ 0.51) and the non-matched (D ≤ 0.43) comparison as matched manual analyses (D ≤ 0.41).
Conclusion: The fully automated T2 analysis showed a high agreement, acceptable accuracy, and similar sensitivity to cross-sectional and longitudinal laminar T2 differences in an early OA model, compared with manual expert analysis.
{"title":"Evaluation of an automated laminar cartilage T2 relaxation time analysis method in an early osteoarthritis model.","authors":"Wolfgang Wirth, Susanne Maschek, Anna Wisser, Jana Eder, Christian F Baumgartner, Akshay Chaudhari, Francis Berenbaum, Felix Eckstein","doi":"10.1007/s00256-024-04786-1","DOIUrl":"https://doi.org/10.1007/s00256-024-04786-1","url":null,"abstract":"<p><strong>Objective: </strong>A fully automated laminar cartilage composition (MRI-based T2) analysis method was technically and clinically validated by comparing radiographically normal knees with (CL-JSN) and without contra-lateral joint space narrowing or other signs of radiographic osteoarthritis (OA, CL-noROA).</p><p><strong>Materials and methods: </strong>2D U-Nets were trained from manually segmented femorotibial cartilages (n = 72) from all 7 echoes (All<sub>E</sub>), or from the 1st echo only (1<sup>st</sup><sub>E</sub>) of multi-echo-spin-echo (MESE) MRIs acquired by the Osteoarthritis Initiative (OAI). Because of its greater accuracy, only the All<sub>E</sub> U-Net was then applied to knees from the OAI healthy reference cohort (n = 10), CL-JSN (n = 39), and (1:1) matched CL-noROA knees (n = 39) that all had manual expert segmentation, and to 982 non-matched CL-noROA knees without expert segmentation.</p><p><strong>Results: </strong>The agreement (Dice similarity coefficient) between automated vs. manual expert cartilage segmentation was between 0.82 ± 0.05/0.79 ± 0.06 (All<sub>E</sub>/1<sup>st</sup><sub>E)</sub> and 0.88 ± 0.03/0.88 ± 0.03 (All<sub>E</sub>/1<sup>st</sup><sub>E</sub>) across femorotibial cartilage plates. The deviation between automated vs. manually derived laminar T2 reached up to - 2.2 ± 2.6 ms/ + 4.1 ± 10.2 ms (All<sub>E</sub>/1<sup>st</sup><sub>E</sub>). The All<sub>E</sub> U-Net showed a similar sensitivity to cross-sectional laminar T2 differences between CL-JSN and CL-noROA knees in the matched (Cohen's D ≤ 0.54) and the non-matched (D ≤ 0.54) comparison as the matched manual analyses (D ≤ 0.48). Longitudinally, the All<sub>E</sub> U-Net also showed a similar sensitivity to CL-JSN vs. CS-noROA differences in the matched (D ≤ 0.51) and the non-matched (D ≤ 0.43) comparison as matched manual analyses (D ≤ 0.41).</p><p><strong>Conclusion: </strong>The fully automated T2 analysis showed a high agreement, acceptable accuracy, and similar sensitivity to cross-sectional and longitudinal laminar T2 differences in an early OA model, compared with manual expert analysis.</p><p><strong>Trial registration: </strong>Clinicaltrials.gov identification: NCT00080171.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-03DOI: 10.1007/s00256-024-04782-5
R Meli, M Hussein, M Czyz, R Henderson, S Vaiyapuri, U Pohl, C Azzopardi, R Botchu
{"title":"Increasing lower back pain with right L4 radiculopathy: question.","authors":"R Meli, M Hussein, M Czyz, R Henderson, S Vaiyapuri, U Pohl, C Azzopardi, R Botchu","doi":"10.1007/s00256-024-04782-5","DOIUrl":"https://doi.org/10.1007/s00256-024-04782-5","url":null,"abstract":"","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-02DOI: 10.1007/s00256-024-04781-6
Jatinder Pal Singh, Sahil Loomba, Bishika Pun, Somesh Virmani
The accessory anterolateral talar facet (AALTF) is an anatomical variation that broadens the apex of the lateral talar process. Studies have associated it with other tarsal coalitions as a cause of rigid painful flatfoot. However, a coalition of an AALTF has never been described before. With the advent of MRI, there has been an increase in the detection of these accessory facets. Nevertheless, owing to its small size and unfamiliarity, it is not easily identified. Proper assessment of imaging findings and associated conditions is needed to confirm the diagnosis. Imaging findings in a series of four patients with painful rigid flatfoot revealed the presence of an AALTF with adjacent marrow edema and reduced joint space. This was associated with hindfoot valgus and subfibular impingement. Radiographic suspicion of a non-osseous coalition of AALTF was raised, which was confirmed intraoperatively in one of the patients and demonstrated on CT and MR images in the other patients. This case series presents rare cases of non-osseous coalition of AALTF with a new radiographic sign, the 'reverse tip of the iceberg sign'.
{"title":"Non-osseous coalition of accessory anterolateral talar facet-A case series.","authors":"Jatinder Pal Singh, Sahil Loomba, Bishika Pun, Somesh Virmani","doi":"10.1007/s00256-024-04781-6","DOIUrl":"https://doi.org/10.1007/s00256-024-04781-6","url":null,"abstract":"<p><p>The accessory anterolateral talar facet (AALTF) is an anatomical variation that broadens the apex of the lateral talar process. Studies have associated it with other tarsal coalitions as a cause of rigid painful flatfoot. However, a coalition of an AALTF has never been described before. With the advent of MRI, there has been an increase in the detection of these accessory facets. Nevertheless, owing to its small size and unfamiliarity, it is not easily identified. Proper assessment of imaging findings and associated conditions is needed to confirm the diagnosis. Imaging findings in a series of four patients with painful rigid flatfoot revealed the presence of an AALTF with adjacent marrow edema and reduced joint space. This was associated with hindfoot valgus and subfibular impingement. Radiographic suspicion of a non-osseous coalition of AALTF was raised, which was confirmed intraoperatively in one of the patients and demonstrated on CT and MR images in the other patients. This case series presents rare cases of non-osseous coalition of AALTF with a new radiographic sign, the 'reverse tip of the iceberg sign'.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142111937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-02DOI: 10.1007/s00256-024-04784-3
Wei Xue, Juanqin Niu, Gang Chen, Yao He, Xuesong Du, Fang Jingqin
Objective
Five cases of giant cell tumor of bone (GCTB) in the head and neck region were reported, with a main focus on the radiological findings to identify common characteristics for the diagnosis of GCTB in these sites.
Materials and methods
Five consecutive patients diagnosed with GCTB were retrospectively selected. Radiological features on conventional and advanced MR sequences and CT were analyzed. HE staining and immunohistochemical examination were performed using antibodies against p63 and CD68.
Results
The common clinical features were local mass (3/5), tinnitus (3/5) and headache (2/5). Radiologically, all the cases were well-circumscribed osteolytic lesion, majority of cases demonstrated an expansile growth pattern and “soap bubble” appearance on CT (4/5). On MRI, the tumors showed predominantly hypointensity both on T1WI and T2WI, and no evidence of restricted diffusion on DWI. Intratumoral hemorrhage (2/5), cystic alternation (2/5) and very low signal on T2WI in the periphery region of the tumor (4/5) was found. Fluid–fluid level was noted in one case, which was eventually verified to be GCTB with secondary aneurysmal bone cyst (ABC). With contrast agent, all the cases showed striking (3/5) or mild to intermediate (2/5) enhancement.
Conclusions
Although the above described radiological findings are not specific for GCTB in head and neck region, a well-defined osteolytic lesion in the bones of head and neck region with “soap bubble” appearance on CT and hypointensity on T2WI with very low signal in the peripheral region of the tumor on MRI highly suggest GCTB for patient ages 20 to 40.
{"title":"Giant cell tumor of bone of temporal bone and skull base: report of 6 cases","authors":"Wei Xue, Juanqin Niu, Gang Chen, Yao He, Xuesong Du, Fang Jingqin","doi":"10.1007/s00256-024-04784-3","DOIUrl":"https://doi.org/10.1007/s00256-024-04784-3","url":null,"abstract":"<h3 data-test=\"abstract-sub-heading\">Objective</h3><p>Five cases of giant cell tumor of bone (GCTB) in the head and neck region were reported, with a main focus on the radiological findings to identify common characteristics for the diagnosis of GCTB in these sites.</p><h3 data-test=\"abstract-sub-heading\">Materials and methods</h3><p>Five consecutive patients diagnosed with GCTB were retrospectively selected. Radiological features on conventional and advanced MR sequences and CT were analyzed. HE staining and immunohistochemical examination were performed using antibodies against p63 and CD68.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>The common clinical features were local mass (3/5), tinnitus (3/5) and headache (2/5). Radiologically, all the cases were well-circumscribed osteolytic lesion, majority of cases demonstrated an expansile growth pattern and “soap bubble” appearance on CT (4/5). On MRI, the tumors showed predominantly hypointensity both on T1WI and T2WI, and no evidence of restricted diffusion on DWI. Intratumoral hemorrhage (2/5), cystic alternation (2/5) and very low signal on T2WI in the periphery region of the tumor (4/5) was found. Fluid–fluid level was noted in one case, which was eventually verified to be GCTB with secondary aneurysmal bone cyst (ABC). With contrast agent, all the cases showed striking (3/5) or mild to intermediate (2/5) enhancement.</p><h3 data-test=\"abstract-sub-heading\">Conclusions</h3><p>Although the above described radiological findings are not specific for GCTB in head and neck region, a well-defined osteolytic lesion in the bones of head and neck region with “soap bubble” appearance on CT and hypointensity on T2WI with very low signal in the peripheral region of the tumor on MRI highly suggest GCTB for patient ages 20 to 40.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142209346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-02-21DOI: 10.1007/s00256-024-04597-4
Tobias Pogarell, Rafael Heiss, Rolf Janka, Armin M Nagel, Michael Uder, Frank W Roemer
This narrative review explores recent advancements and applications of modern low-field (≤ 1 Tesla) magnetic resonance imaging (MRI) in musculoskeletal radiology. Historically, high-field MRI systems (1.5 T and 3 T) have been the standard in clinical practice due to superior image resolution and signal-to-noise ratio. However, recent technological advancements in low-field MRI offer promising avenues for musculoskeletal imaging. General principles of low-field MRI systems are being introduced, highlighting their strengths and limitations compared to high-field counterparts. Emphasis is placed on advancements in hardware design, including novel magnet configurations, gradient systems, and radiofrequency coils, which have improved image quality and reduced susceptibility artifacts particularly in musculoskeletal imaging. Different clinical applications of modern low-field MRI in musculoskeletal radiology are being discussed. The diagnostic performance of low-field MRI in diagnosing various musculoskeletal pathologies, such as ligament and tendon injuries, osteoarthritis, and cartilage lesions, is being presented. Moreover, the discussion encompasses the cost-effectiveness and accessibility of low-field MRI systems, making them viable options for imaging centers with limited resources or specific patient populations. From a scientific standpoint, the amount of available data regarding musculoskeletal imaging at low-field strengths is limited and often several decades old. This review will give an insight to the existing literature and summarize our own experiences with a modern low-field MRI system over the last 3 years. In conclusion, the narrative review highlights the potential clinical utility, challenges, and future directions of modern low-field MRI, offering valuable insights for radiologists and healthcare professionals seeking to leverage these advancements in their practice.
这篇叙述性综述探讨了现代低场(≤ 1 特斯拉)磁共振成像(MRI)在肌肉骨骼放射学中的最新进展和应用。一直以来,高场磁共振成像系统(1.5 T 和 3 T)因其卓越的图像分辨率和信噪比而成为临床实践中的标准。然而,低场磁共振成像技术的最新进展为肌肉骨骼成像提供了广阔的前景。本文介绍了低场核磁共振成像系统的一般原理,重点介绍了与高场核磁共振成像系统相比,低场核磁共振成像系统的优势和局限性。重点介绍了硬件设计方面的进步,包括新型磁体配置、梯度系统和射频线圈,这些技术提高了图像质量,减少了易感伪影,尤其是在肌肉骨骼成像方面。目前正在讨论现代低场磁共振成像在肌肉骨骼放射学中的不同临床应用。介绍了低场磁共振成像在诊断各种肌肉骨骼病变(如韧带和肌腱损伤、骨关节炎和软骨损伤)方面的诊断性能。此外,还讨论了低场磁共振成像系统的成本效益和可及性,使其成为资源有限或病人群体特殊的成像中心的可行选择。从科学的角度来看,有关低场强度下肌肉骨骼成像的可用数据数量有限,而且通常已有几十年的历史。本综述将对现有文献进行深入分析,并总结我们在过去三年中使用现代低场磁共振成像系统的经验。总之,这篇叙述性综述强调了现代低场磁共振成像的潜在临床用途、挑战和未来发展方向,为放射科医生和医疗保健专业人员在实践中寻求利用这些进步提供了宝贵的见解。
{"title":"Modern low-field MRI.","authors":"Tobias Pogarell, Rafael Heiss, Rolf Janka, Armin M Nagel, Michael Uder, Frank W Roemer","doi":"10.1007/s00256-024-04597-4","DOIUrl":"10.1007/s00256-024-04597-4","url":null,"abstract":"<p><p>This narrative review explores recent advancements and applications of modern low-field (≤ 1 Tesla) magnetic resonance imaging (MRI) in musculoskeletal radiology. Historically, high-field MRI systems (1.5 T and 3 T) have been the standard in clinical practice due to superior image resolution and signal-to-noise ratio. However, recent technological advancements in low-field MRI offer promising avenues for musculoskeletal imaging. General principles of low-field MRI systems are being introduced, highlighting their strengths and limitations compared to high-field counterparts. Emphasis is placed on advancements in hardware design, including novel magnet configurations, gradient systems, and radiofrequency coils, which have improved image quality and reduced susceptibility artifacts particularly in musculoskeletal imaging. Different clinical applications of modern low-field MRI in musculoskeletal radiology are being discussed. The diagnostic performance of low-field MRI in diagnosing various musculoskeletal pathologies, such as ligament and tendon injuries, osteoarthritis, and cartilage lesions, is being presented. Moreover, the discussion encompasses the cost-effectiveness and accessibility of low-field MRI systems, making them viable options for imaging centers with limited resources or specific patient populations. From a scientific standpoint, the amount of available data regarding musculoskeletal imaging at low-field strengths is limited and often several decades old. This review will give an insight to the existing literature and summarize our own experiences with a modern low-field MRI system over the last 3 years. In conclusion, the narrative review highlights the potential clinical utility, challenges, and future directions of modern low-field MRI, offering valuable insights for radiologists and healthcare professionals seeking to leverage these advancements in their practice.</p>","PeriodicalId":21783,"journal":{"name":"Skeletal Radiology","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11303481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139913432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}